Newbie having trouble interpreting data

[dlchance]

I am new to cpap - only about 2-1/2 weeks now. At the age of 58 should have been on cpap in my 20's - that's how long my wife has been trying to get past my stubborn thick skull. Now that I am on cpap I am trying to make sense of the data. My diagnosed AHI was over 90. With cpap my average is staying up around 35. I am on a Remstar Auto A-flex with humidifier and a Quatro Mirage mask. Have troubles with leaks sometimes but have kept that down to a dull roar. 90% pressure maintains around 19 and my prescribed setting is 10-20. Other than that the data doesn't make a lot of sense. Have tried Sleepyhead but found out it does not support the new 60 series machine I have (560P). Have tried the Onkor site but gives me strange data. E.g. - I upload the files from the previous night of use - over 6 hours - and the Onkor site only gives me around 30 - 45 minutes of data. Will the Encore Pro 2 work with the new 60 series machines? If so, where can I download? I feel confident that if I could see real-time data I would have a better understanding of what's happening. I have dealt with interpreting data all my adult life with my job and would like now to see some data that has an impact on my life. My biggest concern is reading that many others have AHI averages <5. My doctor is almost non-existent when it comes to getting information. Help!!

[Pugsy]

Give me a couple of minutes and I will send you a private message and get you started on using the software to help you see what is going on.

BTW..your humidifier choice is wrong in your profile. That one doesn't go with your machine. Not a critical issue but it will confuse people.
In the Equipment section...your correct choice is PR System One Heated Humidifier.

Welcome to the forum. Do go ahead and read the glossary in my signature for SH. I combined ResMed and Respironics glossaries and the glossary in the software that I am going to send you was missing a few things.

Once you get your graphs...look for the daily detailed graphs and not so much the summaries for answers right now.
You can post an image of your daily reports for review here. If you don't know how to do that...this is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here. (if you choose photobucket it is the last line in the box that has the URL addys)
Use the preview button. If you can't see the image try again because if you can't see it we can't.

[Pugsy]

For anyone wondering...Encore Pro 2 actually has more than one version. There are 2.2, 2.4, 2.5 and 2.8 versions of Encore Pro. Only version 2.8 works with the new 60 series machines.
EncoreBasic is a smaller version of 2.8. Smaller as in physical size of the program and not smaller because of less reporting capabilities. Reports are identical. Basic even offers waveform...there is zero need to use Pro if someone uses Basic.
Don't let the Basic part of the name mislead you.

[dlchance]

Give me a couple of minutes and I will send you a private message and get you started on using the software to help you see what is going on.

BTW..your humidifier choice is wrong in your profile. That one doesn't go with your machine. Not a critical issue but it will confuse people.
In the Equipment section...your correct choice is PR System One Heated Humidifier.

Welcome to the forum. Do go ahead and read the glossary in my signature for SH. I combined ResMed and Respironics glossaries and the glossary in the software that I am going to send you was missing a few things.

Once you get your graphs...look for the daily detailed graphs and not so much the summaries for answers right now.
You can post an image of your daily reports for review here. If you don't know how to do that...this is how I do it.

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.

Once the screen shot is created save it in jpg format.
Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here. (if you choose photobucket it is the last line in the box that has the URL addys)
Use the preview button. If you can't see the image try again because if you can't see it we can't.

Thanks for the information. I have corrected my profile and will post some of the images in a few days. Hoping to beat this thing as I have not had a decent day of not feeling extremely tired in 30 years and am ready for a change. Have already learned more from this forum than the doctos and clinicians have even attempted to tell me. Thanks to all of you for your input and help.

[chunkyfrog]

Sadly, poor knowledge about sleep apnea and its treatment extends to many professionals who should be informed.
Patients are often ahead of the curve; especially here.
Welcome.

[Janknitz]

Once you get the data dialed in we may be able to help more. 35 AHI is still very high (a good treated AHI should be well under 5), but there are some factors to consider:

1. All you can see on your screen is 7 and 30 day averages. If you were having a lot of leak issues in the first few days, then the data averages may be very skewed. I don't think that explains everything, but it does complicate matters if you're trying to base anything off averages.

2. Were you TITRATED at 10 to 20, or is this setting being used to titrate you at home? If you were titrated at 10 to 20, did they get good control of your apneas? A big, wide setting (10 to 20) can sometimes contribute to the apneas because the machine has to play "catch up", but if you were titrated to those pressures and still had a high AHI then the machine may be the wrong machine for you but they need you to "fail" at CPAP before they can give you a different type of machine.

3. When do you see your doctor for a follow-up? Clearly, you are not getting any therapuetic benefits yet, since and AHI of 35 is still considered severe apnea. You should try to call your doctor to get in sooner, if the next appointment isn't for a few weeks yet.

[dlchance]

Once you get the data dialed in we may be able to help more. 35 AHI is still very high (a good treated AHI should be well under 5), but there are some factors to consider:

1. All you can see on your screen is 7 and 30 day averages. If you were having a lot of leak issues in the first few days, then the data averages may be very skewed. I don't think that explains everything, but it does complicate matters if you're trying to base anything off averages.

2. Were you TITRATED at 10 to 20, or is this setting being used to titrate you at home? If you were titrated at 10 to 20, did they get good control of your apneas? A big, wide setting (10 to 20) can sometimes contribute to the apneas because the machine has to play "catch up", but if you were titrated to those pressures and still had a high AHI then the machine may be the wrong machine for you but they need you to "fail" at CPAP before they can give you a different type of machine.

3. When do you see your doctor for a follow-up? Clearly, you are not getting any therapuetic benefits yet, since and AHI of 35 is still considered severe apnea. You should try to call your doctor to get in sooner, if the next appointment isn't for a few weeks yet.

My next appointment to see the Dr is on Thursday, 6/21 . Will find out more then and will check back in to give fresher information. I am seeing a lot of leak problems on my charts and now need to solve those before I wig out. Thanks for the info. I am armed with a battery of questions for my Dr.

[dlchance]

As I noted in my last post, I will be seeing the Dr tomorrow for the first time since my initial sleep study. In the meantime, I have posted a detailed report below from 6/18/12 which was one of my better nights. Although I am just now beginning to understand some of the data, would anyone generally agree that the leaking problems could be the overall cause of my high AHI of around 35? I am going to talk to Dr about the mask and possibly try a full face mask. My Quattro Mirage feels good (as good goes with a foreign object strapped to my face) but I am having a terrible problem in the middle of the night with leaks around my cheeks. The slightest move on my part starts an annoying leak and I have tried tightening, loosening, cleaning, etc. to no avail. Will provide more info after I see the doc.

[Pugsy]

would anyone generally agree that the leaking problems could be the overall cause of my high AHI of around 35?

No, your leaks are not an issue at all unless they are waking you up. Your leak line (except for the spikes which are very short lived and aren't the cause of the events) is well within acceptable limits for the pressures being used.
For leaks to have been a possible culprit..they would need to be up in the 80 L/min plus area for the entire night and yours is well under that.

Your AHI is high because the machine is maxing out the pressure and it is not able to deal with the events properly.
It is staying maxed out most of the night so we can't even blame the response time for the starting at 10 cm...The pressure maxes out and the the events are not prevented. Looks like you need more pressure.
Increasing the minimum pressure from 10 cm might help a little but I don't think it will make the difference that you need.
Then we have the clear airways on the side line. I am thinking different machine....at least a plain BiPap that allows for higher pressures maybe one of the high dollar fancy BiPaps.

There is no need to change masks...leaks are not the problem and all those events won't be fixed by using another mask type. Unless you just want to try a different one..but I really don't think it will help.
Your problem is pressure needs. APAP machine only goes to 20 cm....looks like you need more pressure.

[dlchance]

would anyone generally agree that the leaking problems could be the overall cause of my high AHI of around 35?

No, your leaks are not an issue at all unless they are waking you up. Your leak line (except for the spikes which are very short lived and aren't the cause of the events) is well within acceptable limits for the pressures being used.
For leaks to have been a possible culprit..they would need to be up in the 80 L/min plus area for the entire night and yours is well under that.

Your AHI is high because the machine is maxing out the pressure and it is not able to deal with the events properly.
It is staying maxed out most of the night so we can't even blame the response time for the starting at 10 cm...The pressure maxes out and the the events are not prevented. Looks like you need more pressure.
Increasing the minimum pressure from 10 cm might help a little but I don't think it will make the difference that you need.
Then we have the clear airways on the side line. I am thinking different machine....at least a plain BiPap that allows for higher pressures maybe one of the high dollar fancy BiPaps.

There is no need to change masks...leaks are not the problem and all those events won't be fixed by using another mask type. Unless you just want to try a different one..but I really don't think it will help.
Your problem is pressure needs. APAP machine only goes to 20 cm....looks like you need more pressure.

Thanks for the quick response. Since my last post I have noticed a couple of things that caught my eye on all the reports starting with 5/29 thru 6/18. The thing that caught my attention was the fact that my VS (Vibratory Snore) completely DISAPPEARS when I reach a pressure of around 18cm and above. With that in mind, I now have an issue to discuss with my doctor because 1 thing I remember clearly from my 2nd night of titration was that the technician told me that he never "quite" reached full titration. And something that has puzzled me since the sleep study was that my machine does not catch my breath when putting on or removing the mask while pressurized. The machine used at the hospital took my breath away until I learned to just hold me breath while donning the mask. I don't have to hold me breath with y machine.

Thanks for your response. The more I read, the more I know that I am going to have to get a good grip on my treatment before it will show me the kind of results that I should be expecting.

[Pugsy]

The thing that caught my attention was the fact that my VS (Vibratory Snore) completely DISAPPEARS when I reach a pressure of around 18cm and above.

Don't get too excited. Respronics machines quite flagging snores at pressures above 16 cm automatically.
Just because they don't show up...doesn't mean they aren't there. I am sure they have their reasons for this but I don't know what they are. Bummer I know...just when you thought something was improved...sorry.

I am not surprised that they couldn't reach "full titration" not at those pressures and possible time constraints and difficulty sleeping in a sleep lab...and with a hurricane blowing up your nose.

You likely need a bilevel machine of some sort which allows for the greater pressures you are going to need along with more comfort while using those pressures. Some insurance companies require that someone at least try the lower cost option machines first before they will pay for the higher priced machines. I use a bilevel machine. Not because of higher pressures though...just because I like it. My bilevel machine is what I call a plain bilevel machine (it does auto adjust but doesn't breathe for me) and it costs roughly about twice what a regular machine would cost...now the really high end bilevel machines cost a whole lot more than my bilevel machine...so sometimes we have to try the other to prove the need for the higher end machines.
If you can get by with a machine like mine then that would be simpler, cheaper and easier adjustment than trying to use the high end ASV type of machine.

[dlchance]

The thing that caught my attention was the fact that my VS (Vibratory Snore) completely DISAPPEARS when I reach a pressure of around 18cm and above.

Don't get too excited. Respronics machines quite flagging snores at pressures above 16 cm automatically.
Just because they don't show up...doesn't mean they aren't there. I am sure they have their reasons for this but I don't know what they are. Bummer I know...just when you thought something was improved...sorry.

I am not surprised that they couldn't reach "full titration" not at those pressures and possible time constraints and difficulty sleeping in a sleep lab...and with a hurricane blowing up your nose.

You likely need a bilevel machine of some sort which allows for the greater pressures you are going to need along with more comfort while using those pressures. Some insurance companies require that someone at least try the lower cost option machines first before they will pay for the higher priced machines. I use a bilevel machine. Not because of higher pressures though...just because I like it. My bilevel machine is what I call a plain bilevel machine (it does auto adjust but doesn't breathe for me) and it costs roughly about twice what a regular machine would cost...now the really high end bilevel machines cost a whole lot more than my bilevel machine...so sometimes we have to try the other to prove the need for the higher end machines.
If you can get by with a machine like mine then that would be simpler, cheaper and easier adjustment than trying to use the high end ASV type of machine.

That is a bummer. Just goes to show, going to have to keep on truckin' until this thing is licked. Will now wait to see what the doc has to say about a Bipap. Forward ho...............